Su1034 OUTCOMES OF PALLIATIVE TREATMENT FOR MALIGNANT GASTROINTESTINAL OBSTRUCTION WITH PERITONEAL CARCINOMATOSIS: STENT PLACEMENT VERSUS PALLIATIVE SURGERY AND PREDICTORS OF STENT FAILURE

Abstract

Management of malignant gastrointestinal obstruction (MGIO) is more challenging in presence of peritoneal carcinomatosis (PC). Outcome data to guide the management of MGIO with PC is lacking. We aimed to comparethe clinical outcomes and adverse events between endoscopic and surgical palliation and identify predictors of stent success in patients with MGIO with PC. Consecutive patients with MGIO with PCbetween 2000 and 2018underwent palliative surgery or enteral stenting at a tertiary medical center were included. All patients had pathologically proven malignancy and were not candidates for curative treatment. Technical success was defined as a successful deployment of the stent across the stricture site confirmed by post-intervention imaging in the stent group and absence of bowel leak or post-operative wound dehiscence within the first week in the surgery group. Early clinicalsuccess was defined as successful relief of obstructive symptoms within the first week after the intervention. Overall clinical success was defined as relief of obstructive symptoms with or without additional rescue stenting within 30 days. A binary logistic regression analysis was used to investigate potential factors influencing clinical success in the stent group. Fifty-seven patients with enteral stenting and 40 with palliative surgery were compared. Baseline patient and tumor characteristics were not significantly different between the two groups (Table 1). The two groups did not differ in the rates of technical success, 30-day mortality, or recurrence. Overall clinical success (surgery: 95% versus stent: 78.9%), luminal patency duration (145 versus 27 days), and survival length (336 versus 148 days) favored palliative surgery (all P < 0.05) but the patients in surgery group had a trend towards better ECOG status. The rate of adverse events (10.5% vs. 50%), severity of adverse events, and length of hospital stay (4.5 days vs. 9 days) favored enteral stenting (all P< 0.05) (Table 2). Need for more than one stent was associated with higher likelihood of failure (odd ratios [OR]=0.2, P=0.02). Despite not statistically significant, upper gastrointestinal obstruction (OR=2.67) and receipt of chemotherapy (OR=2.36) were favoring clinical success whereas obstruction length (OR=0.89), poor preoperative performance status (OR=0.62), and the presence of diverticulosis (OR=0.70) were favoring clinical failure. Our study, largest series to date, suggests that enteral stenting is safer and able to offer a shorter hospital stay than palliative surgery, though unlike other MGIOs, clinical success is lower in MGIO with PC. Identifying right candidates and potential predictors of clinical success in ECOG-matched large-scale studies are needed to validate these results.View Large Image Figure ViewerDownload Hi-res image Download (PPT)